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NPI Code Detail

MEDICARE: MYKEISHA L YOUNG DPT

MEDICARE: MYKEISHA L YOUNG DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist26937MD
2225100000XPhysical TherapistCP014311TVA

General Provider Information

NPI Number : 1144727041
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYKEISHA L YOUNG DPT
Provider Business Mailing Address
First Line : 350 NEW FIDELITY CT
Second Line :
City : GARNER
State : NC
Zip : 27529-2665
Country : US
Telephone Number : 919-756-3107
Fax Number : 919-535-3271
Provider Business Practice Location Address
First Line : 43490 YUKON DR STE 212
Second Line :
City : ASHBURN
State : VA
Zip : 20147-7326
Country : US
Telephone Number : 703-729-7920
Fax Number : 703-729-7923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 10/25/2022

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Directions to “ MYKEISHA L YOUNG DPT” Practice Location

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